Inspection on 31/05/05 for St Andrews Lodge Care Home

This inspection was carried out on 31st May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Andrews Lodge Care Home 29/03/10

St Andrews Lodge Care Home 15/01/10

St Andrews Lodge Care Home 04/11/08

St Andrews Lodge Care Home 15/11/07

St Andrews Lodge Care Home 08/03/07

St Andrews Lodge Care Home 09/05/06

St Andrews Lodge Care Home 08/11/05

St Andrews Lodge Care Home 23/11/04

St Andrews Lodge Care Home 31/08/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Andrews Lodge Care Home Riber Crescent Basford Nottingham NG5 1LP Lead Inspector Mary OLoughlin Unannounced 31 May 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Andrews Lodge Care Home Address Riber Crescent Basford Nottingham NG5 1LP 0115 9245467 0115 9245485 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Trinity Care Ltd CRH, N, Care home with nursing 80 Category(ies) of DE Dementia, male and female, x 80 registration, with number MD Mental Disorder, male and female, x 80 of places St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Out of the total number of beds up to 10 beds can be used for service users aged between 50 & 65 years. Date of last inspection 23 November 2004 Brief Description of the Service: St. Andrews Lodge provides nursing care for 80 older people with Mental Illness and for those with Dementia. The registration allows for up to 10 people between the ages of 50- 65yrs to be accommodated. The home is split into two separate units, Garden and Assisi. Southern Cross Healthcare Ltd is the registered provider and all beds accommodate people that are in need of continuing care under the Health Authority. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over 6hrs and was unannounced. On this occasion Assisi Unit was inspected. The main method of inspection was case tacking, this is looking at the care plans of the residents to ensure they are receiving appropriate assessment, treatment and review of their needs. The resident’s case tracked were unable to give an account of their care due to their deteriorating health. Two relatives were spoken with and seven members of staff, including the deputy manager and acting manager. One relative was very happy with the care provided at the home, however the second relative felt there was a lack of consultation with staff and relatives to ensure that care being delivered was appropriate and met the expectations of the individual. The unit has a staff team that is sufficient in numbers to meet the assessed needs of the residents. The environment is generally clean and well maintained offering appropriate precautions to maintain the health and wellbeing of the residents. Health care is managed by the Consultant Psychiatrists under the continuing care contract between the home and the Health Authority. Qualified Nurses plan the care delivery but there is inadequate consultation between the resident, their relatives and the staff at the home to ensure that the plan of care is agreed by all parties. The home was warm and well maintained. There were appropriate numbers of staff on duty and staff were accessing training in the needs of the residents. The continuing care contract with the Health Authority is under review. What the service does well: The home provides a safe environment for people with Mental Illness and Dementia. The home responds in a timely fashion to any allegations of abuse or suspicions of abuse. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 6 There is good access to all specialists services, the Psychiatrist, occupational therapist and physiotherapist. There is good practice ensuring that the residents receive a wholesome and nutritious diet. What has improved since the last inspection? What they could do better: More consultation with the residents and their relatives is required when planning care to ensure that everyone is agreed on the care to be provided. More robust protection is required for those people that lack capacity to manage their own affairs to ensure that their finances are managed in their best interests. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 7 Reviewing certain care practices to ensure that all actions undertaken are considered to be appropriate for the individual resident rather than a blanket protocol that does not consider the effect on the individual. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4 The home’s practices at the point of admission do not reflect person centred care, which would ensure that as far as possible the resident receives appropriate methods of assessment according to their needs. EVIDENCE: Through recent complaint investigations it is evident that the home’s practice of bathing or showering people soon after admission to determine the skin condition of the resident can be distressing. Consideration of the disorientation of the resident at the point of admission and the possible distress that this procedure could cause, particularly where the resident was not familiar with the staff undertaking the practice could cause unnecessary distress and should be reviewed to look at other less intrusive methods of skin assessment. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-8-9-10 The lack of clear care plans that spell out how the needs of the resident are to be met and monitored leaves some aspects of the care dependent on memory and good knowledge of the resident by the staff to ensure continuity. The lack of consultation with relatives is poor practice. These shortfalls have the potential to put the residents at risk. EVIDENCE: Residents case tracked had impaired judgement and were unable to communicate with the inspector. Three care plans examined show that each person received an appropriate assessment of their needs, which is undertaken by a qualified nurse at the point of admission and then regularly reviewed. The care plans are based on a nursing model, which tends to focus on problems rather than strengths and weaknesses. Appropriate risk assessment is undertaken and reviewed monthly. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 11 Information collated on the residents social history was not always translated into the care plan to provide a more person centred care plan which would be good practice for those people with deteriorating conditions such as Dementia. One relative spoken with had not been properly consulted on all aspects of her husbands care and this had caused her distress. Staff spoken with had not generally consulted relatives in care planning. Named nurses spoken with were not able to recall the previous interests of a recent admission or confirm if the home had used the information in any way to inform how the person’s social care would be managed. Care plans such as the oral health of the resident did not contain sufficient detail on which to deliver care and did not provide evidence of dental health. It would be best practice to include matters such as whether the person has teeth or dentures and if they have a visiting dentist. Reviews could then ensure that the person was actually referred and seen by the dentist on a regular basis, providing a clear history of the events. The same problem exists in managing chiropody and opthalmology, if the care plans stated the arrangements in place, the review would provide monthly monitoring to ensure continuity and access as required. There was a marked improvement on the nutritional care plans and subsequent monitoring of resident’s diet intake since the previous inspection. Where nutritional risk is identified there are appropriate strategies in place such as referral to the community dietician. There was clear evidence that resident’s weight had increased following appropriate support. One resident case tracked had a high risk of developing pressure sores, his care plans reflected good practice in the provision of appropriate pressure relieving equipment and positional changes which had maintained his tissue viability. The equipment was seen in place and the care plan followed. Each resident is reviewed by the placing Psychiatrist regularly who manages the mental health issues of the resident. Separate records of external specialists and members of the Multidisciplinary team are held within the care files, this provides appropriate monitoring and support of people’s mental health conditions. General health matters are managed by the resident’s General Practioner. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 12 The three residents case tracked had received appropriate management and review of their medicines. The medicines are recorded into the home and at the point of administration, which provides a safe audit trail. During the inspection staff were seen to treat people respectfully and maintain their dignity throughout personal care and support. Staff spoken with confirmed they had received an induction and were instructed on how to treat people respectfully. Relatives spoken with confirmed that they were happy with the laundry arrangements and people were able to wear their own clothes at all times. There was no evidence of legal or financial advice referral for those people unable to manage their own affairs, which is necessary given the deteriorating conditions of the residents accommodated. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-13-15 A varied and full social calendar is provided. Meals are well managed, varied and wholesome. Resident’s previous interests are not always considered which may not provide the continuity and familiarity that people with deteriorating conditions require to maintain their optimum level of functioning. EVIDENCE: At the point of admission a social assessment is undertaken which considers the previous interests, likes and dislikes of the resident. This information was not translated into a social care plan for service users case tracked. The records of social and recreational activities undertaken are held and reflect a range of opportunities available to residents. A full time activities worker is employed. Resident’s records included entries for home baking, trips out, birthday celebrations and local entertainers visiting the home. A vocalist was entertaining the residents during this inspection. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 14 Activities provided are suitable for the residents accommodated. There are no restrictions on visiting. Residents are assessed for their nutritional needs and meals are provided that reflect the desired diets. Records of the diet provided are held. Staff were seen to assist people to take their meals, this was done in a discreet and respectful manner. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16-18 Complaints are handled appropriately and relatives are given information on how to refer to the Commission for Social Care Inspection if they are unhappy with the response from the home. The protection of vulnerable adults procedure is undertaken wherever required which ensures the protection of the residents. EVIDENCE: The Commission for Social Care Inspection has received three complaints in the last three months, two of which are being investigated under adult protection procedures. The home undertakes appropriate Adult Protection referral and investigation wherever indicated, responding in the appropriate timescale. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-21-22-2324-25-26 The home is well maintained and provides a safe environment for the residents. Improvements in the décor are needed in some areas. Residents are provided with a good range of equipment to enable them to maintain an optimum level of ability. EVIDENCE: The local Fire and Environmental health departments monitor the home and provide regular inspection of the premises. The home was clean and warm. There were some carpets that required cleaning but generally the home was well maintained. Each unit has a keypad lock installed to prevent people who are unsafe or lack judgement to wander from the building unattended. Water was appropriately regulated to ensure peoples safety. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 17 There are sufficient baths and toilets providing appropriate equipment for the residents accommodated. There is a range of equipment in use for the safe moving and handling of the residents. Each room has a floor sensor that alerts staff during the night to those residents that are restless and may fall if getting out of bed unattended. Resident’s rooms were in need of some redecoration. Some were personalised but others sparse. Furnishings are of good quality and provide appropriate storage. A nurse call system is in operation throughout the home and is presently awaiting an upgrade to isolate one unit from the other thereby reducing disturbance particularly at night. An infection control policy and appropriate care practice with the provision of protective clothing, waste disposal and laundry facilities provides safe infection control practice. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-28-29-30 Residents are cared for by appropriate numbers of staff that are familiar with their conditions. The recruitment practice ensures that residents are protected from staff that may be unsuitable to work with vulnerable adults. The records of staff training where not in good order and did not provide an appropriate record of the training needs of the individual staff member which would ensure that each person received the necessary training to undertake their role. EVIDENCE: There were 29 residents accommodated on Assisi Unit at this inspection. The Unit is appropriately staffed with sufficient care staff to meet the individual needs of the service users. There are two qualified nurses on duty during the day and one at night. Duty records did not record the full name of the member of staff. Three staff files were examined which demonstrated appropriate checks were undertaken to ensure that staff unsuitable to work with vulnerable adults are not employed at the home. Staff files were difficult to audit and require better management. Staff undertake an induction at the start of their employment and NVQ training is accessed following the induction period. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 19 Not all qualified staff are trained in the needs of people with Dementia or mental illness, there is however always one person on duty that has these specialist skills. Qualified nurses spoken with felt they could access training appropriate to the needs of the residents, no recent evidence of people actually doing this was seen on file. Care staff could not confirm that they had received training in the specific needs of the residents but records did indicate previous training was undertaken. One relative spoke of being very happy with the care that staff provide and he felt supported by the staff during his visits. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35-36 The manager is not yet registered with the Commission for Social Care Inspection. The manager presently in post provides appropriate staff supervision to ensure that all aspects of the care practice are monitored. For those residents unable to manage their own affairs there were insufficient safeguards in place. Without the referral to legal or financial representatives they may be at risk. EVIDENCE: The manager has applied to register with the Commission for Social Care Inspection. Care plans examined did not indicate how the resident’s personal and financial affairs are managed. The manager confirmed that a number of residents had no legal representation and they were not able to manage their own affairs and did not have any relatives to undertake this for them. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 21 Staff files examined contained records of supervision, which were up to date and provided appropriate supervision of practice and training needs. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 1 3 x x St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4 7 8 Regulation 14 Requirement The registered person must ensure that appropriate consultation takes place regarding 1. The assessment of the resident, with the resident and their relatives as appropriate. 2. Consultation with the resident and the relatives on drawing up the care plan and at reviews of the plan. 3. Ensuring that wherever possible the plans are signed by the resident or the relative. 4. Including information on the (a)recreational needs (b) oral health and arrangements in place to address these needs (c) Optician and Chiropody access arrangements The registered person must ensure that where people lack capacity to manage their own financial affairs and they have no relative acting on their behalf, access to appropriate legal or advocacy support is facilitated. The registered person must ensure that the activities provided suit the residents expectations, preferences and C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Timescale for action October 31st 2005 2. 8 12 October 31st 2005 3. 12 16 October 31st 2005 St Andrews Lodge Care Home Version 1.30 Page 24 4. 30 18 5. 35 12 capacities, using the information collated at the point of admission to formulate a social care plan for the individual. The registered person must ensure that staff training records are held in good order and provide evidence of training undertaken. The registered person must ensure that there are sufficient safeguards in place to protect the interests of the resident who lacks capacioty to manage their own money. October 31st 2005 October 31st 2005 6. 7. 8. 9. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 4 27 Good Practice Recommendations The registered person should look at less intrusive methods of skin examination at the point of a residents admission. The registered person should ensure that the full name of the staff member is included at all times on the duty sheets. St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Andrews Lodge Care Home C53 C03 S26472 St Andrews Lodge V230323 310505 Stage4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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